These answers draw in part from “AAC Scope of Practice and Competence: Thinking about AAC through an Interprofessional Lens” by Teresa Cardon, Ph.D., CCC-SLP, BCBA-D (BehaviorLive), and extend it with peer-reviewed research from our library of 27,900+ ABA research articles. Clinical framing, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →Scope of practice refers to the range of activities a professional is authorized to perform based on their credential. For BCBAs, communication intervention including AAC is within scope of practice. Scope of competence refers to the specific areas within scope of practice where the individual has adequate training, experience, and skill to perform competently. A BCBA may be authorized to work with AAC (scope of practice) but may lack the specific training needed to select an AAC device or conduct a comprehensive AAC evaluation (scope of competence). The BACB Ethics Code (2022) Code 1.05 requires behavior analysts to practice within their boundaries of competence, not just their scope of practice. This distinction is critical for AAC because competent AAC practice requires knowledge beyond standard BCBA training.
A referral is indicated when a client relies primarily on challenging behavior, gestures, or other limited means to communicate basic needs and wants. Other indicators include a significant gap between what the individual seems to understand and what they can express, failure to develop functional speech despite adequate intervention, an existing AAC system that does not meet the individual's current communication needs, communication breakdowns that limit community participation and quality of life, and family or caregiver reports that they frequently cannot understand what the individual wants. The referral should be made to a speech-language pathologist with specific expertise in AAC assessment, as general SLP training may not include the specialized knowledge needed for comprehensive AAC evaluation.
BCBAs are typically competent in several aspects of AAC implementation that draw on behavioral expertise: designing systematic teaching procedures using prompting and fading to teach AAC use, arranging environmental opportunities that motivate communication, implementing mand training to establish functional requesting through AAC, reinforcing communicative attempts to strengthen AAC use, training communication partners to respond to and support AAC use, collecting and analyzing data on communication frequency and quality, troubleshooting motivational barriers to AAC use, and programming for generalization of AAC use across settings. These activities apply behavioral principles to the AAC system recommended by the SLP. Activities outside typical BCBA competence include AAC device selection, vocabulary organization design, and motor access method assessment.
No. Research consistently demonstrates that AAC does not inhibit speech development and may actually support it. Multiple studies have shown that individuals who receive AAC alongside other communication interventions maintain or increase their vocal output. This makes sense from a behavioral perspective: AAC provides a reliable means of communication that is reinforced, which builds the individual's understanding that communication is effective. This positive communication experience can actually support the development of vocal speech. Delaying AAC introduction while waiting for speech to develop is not supported by evidence and may deprive the individual of a functional communication tool during a critical developmental period. BCBAs should share this evidence with families who express concern about AAC and speech.
Common barriers include myths about AAC and speech development, communication partner resistance or lack of training, insufficient environmental opportunities for AAC use, AAC systems that do not match the individual's motor or cognitive abilities, limited vocabulary that restricts the range of communicative functions, organizational or systemic barriers such as lack of funding or professional support, cultural and linguistic mismatches between AAC vocabulary and the individual's home language, and the individual's own preferences or frustrations with the system. BCBAs can address many of these barriers through systematic environmental arrangement, communication partner training, reinforcement-based motivation strategies, and collaborative problem-solving with the SLP. Addressing these barriers proactively increases the likelihood of successful AAC adoption.
AAC data collection should capture multiple dimensions of communication beyond simple frequency counts. Track the variety of communicative functions expressed such as requesting, commenting, protesting, and social interaction. Monitor the range and complexity of vocabulary used over time. Measure the degree of partner independence by recording prompt levels needed for successful communication. Assess the effectiveness of communication by noting whether communication attempts achieved the intended result. Document AAC use across different settings and communication partners to evaluate generalization. Record communication breakdowns and their causes to inform troubleshooting. This multidimensional data approach provides a comprehensive picture that supports both behavioral and speech-language decision-making about the individual's communication program.
A comprehensive AAC assessment conducted by a qualified SLP typically evaluates the individual's current communication abilities across all modalities including speech, gesture, facial expression, and any existing AAC. It assesses receptive and expressive language levels, motor capabilities relevant to AAC access such as pointing accuracy and hand function, vision and hearing to ensure the individual can perceive the AAC system, cognitive-linguistic skills that inform vocabulary representation and organization, communication needs across daily environments, and the preferences of the individual and family. The assessment results in recommendations for a specific AAC system, vocabulary, access method, and implementation plan. Understanding this process helps BCBAs make appropriate referrals and collaborate effectively with the assessing SLP.
Effective collaboration begins with shared understanding of each professional's expertise and role. The SLP typically leads AAC assessment, system selection, vocabulary organization, and language development goals. The BCBA typically leads systematic instruction, motivation and reinforcement strategies, behavior management during AAC teaching, and generalization programming. Both professionals should participate in goal setting, progress monitoring, and decision-making about system modifications. Regular communication through team meetings, shared documentation, and joint observation sessions ensures alignment. When disagreements arise, they should be resolved through discussion of the evidence and the individual's best interest rather than assertions of professional authority.
Aided language modeling, also called aided language input or aided language stimulation, involves communication partners using the individual's AAC system to model language during natural interactions. Rather than only expecting the individual to use the system, partners point to symbols on the AAC device while speaking, demonstrating how the system can be used for various communicative purposes. This strategy is well-supported by AAC research and aligns with behavioral principles of modeling and stimulus-stimulus pairing. BCBAs can train communication partners to implement aided language modeling as part of their behavioral teaching procedures. It is particularly effective for building receptive vocabulary, demonstrating communicative functions, and normalizing AAC use in the individual's environment.
No. The concept of AAC prerequisites, such as requiring individuals to demonstrate matching, picture discrimination, or intentional communication before receiving an AAC system, has been thoroughly challenged by research and professional consensus. Current best practice holds that everyone communicates and that access to AAC should not be gatekept by prerequisite skill demonstrations. The research shows that individuals can learn prerequisite skills through AAC use rather than needing to demonstrate them before access. Behavior analysts who require prerequisites before providing AAC may be unnecessarily restricting a client's access to communication, which conflicts with Code 2.15's requirement for least restrictive effective procedures. AAC access should be provided based on communication need, not skill demonstrations.
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AAC Scope of Practice and Competence: Thinking about AAC through an Interprofessional Lens — Teresa Cardon · 1.5 BACB Ethics CEUs · $15
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.